Sometimes, due to health or other concerns, labor must be induced, or artificially started. Labor inducement can be a long process and induced labor is slightly different than “regular” labor.

Labor can be induced using a variety of methods. Check with your provider to determine which method they prefer to use. Some practitioners prefer to begin the process in the evening, with the hopes that you can sleep through most of the night. Other practitioners prefer to begin in the morning with labor inducements.

How to Induce Labor

The process can take anywhere from 1-3 days depending upon a variety of factors including your health and the overall well being of the baby. Because of the risks, most women who are induced will need to be regularly monitored. This may mean that you are confined to bed for the majority of the process. For some women, this can be bothersome.

I’ve found that contractions are different during inducements. During naturally occurring labor, I found that I was able to work with the contractions. During my inducements, I felt that the contractions were much more powerful and intense. They were also very close together which made me feel very overwhelmed. I ended up asking for pain medication for some of the inducements; with others I was able to get through the process without pain medication. During one of my inducements, it went so quickly that there simply wasn’t time for pain medicine.

Get Support

Getting support during the process is important. It’s also important that your labor support person is aware that this is an inducement and that he or she is aware of the possible complications which could occur during the process. During my most recent inducement, my husband became so discouraged when I “stalled out” at 3 cm for 6 hours. I found myself encouraging him instead of concentrating on the labor!

Be prepared to be flexible. After 18 hours of labor, it appeared that I would need a c-section to complete the delivery because I just wasn’t progressing in my labor stages. I have to say, I was slightly discouraged. By the time the midwife left to make some final arrangements and came back a short time later to discuss options with my husband and I, I had fully dilated. Our son was delivered shortly thereafter.

My grandmother gave me some sage grandparenting advice 16 years ago before the birth of my first child. When I asked her how she handled the demands of childbirth, she simply replied: I kept my eyes on the prize. I find that “keeping my eyes on the prize” is essential to handling an inducement. Hopefully this advice will help you too!

Birth plans have become the next “big thing” for pregnant women who decide that they want to maintain some control in the labor and delivery of their unborn child, as well as in the post-partum care both she and her baby receive in the hospital. Some people do not know how to create a birth plan, or why creating a birth plan is an important aspect of their pregnancy.

When a laboring woman arrives at the hospital, there can be limited time to get her feelings regarding how she wants her labor to progress across to the nurses on duty. Birth plans are generally written by the pregnant woman, sometimes with the assistance of her labor partner several weeks prior to delivery. It should then be taken to your doctor or midwife at one of your prenatal appointments to go over your wishes and make sure that your provider is aware of any concerns you might have.

Flexibility
One thing to keep in mind when creating your birth plan is to maintain flexible. Even if you have the textbook perfect labor and delivery, chances are that something in your birth plan will not be able to be accomplished or achieved. It might be because of your hospital, or it might be as simple as you originally saying that you do not want pain medication, just to change your mind half way through labor. If you remain flexible regarding what you wrote in your birth plan, the day of delivery will go much smoother.

Creating your Birth Plan
So how do you create a birth plan? You can use our customized birth plan creator, or you can create one from scratch. If you create one from scratch, be sure to remember to include everything that you deem important.

Pain Medication
When doing your birth plan be sure to mention your wishes on pain medication. Do you want pain medication or not? If you do want pain medication, how much and what kind do you want? If you want medication, do you want to have just a shot through your IV of something to just dull the pain a bit, or do you want an epidural which will go in your back and pretty much get rid of all pain and contractions that you feel? Do you want the doctor or midwife to suggest to you medication, or not mention it at all?

Episiotomy or Tearing
Also, when creating your birth plan, be sure to let everyone know what you will prefer when it comes to having an episiotomy. An episiotomy is when the doctor or midwife cuts the perineal area that goes from your vagina to your rectum an inch or two before the babies head comes out in order to help the head come out easier. Some women prefer to be cut; other women prefer to tear naturally. Many women’s activist groups these days are promoting tearing vs. no episiotomy because some women won’t tear at all, or only tear a tiny bit, making the healing time less painful than it would have been with an episiotomy.

Visitors
Let the nurses know in your birth plan who you want to be allowed in the room and when. Some women are fine with having everyone in at once, and others prefer to only have their birth partner, or have other visitors come in one at a time. You might want the interaction and distraction during the early stages of labor, but not want a bunch of people in the room towards the end. There are also times when you may not want your parent or an in-law in the room at all, but you do not want to be the bad guy. Buy writing these wishes down in your birth plan, it enables your nurse to tell people who can and can not go in and when, and also makes the nurse be the “bad guy” so you don’t have to concentrate on those issues when you should be concentrating on pushing your baby out.

Immediately After Birth
Assuming you have a vaginal birth, you should include in your birth plan your wishes for the baby immediately after birth. Some women will choose to bank their babies cord blood and will have that set up ahead of time. Others want to make sure the cord stops pulsating before it is cut, letting the baby get the remaining nutrients that are important for their health. If you are breastfeeding, you may want to be allowed to nurse immediately, vs. having to wait several minutes for your baby to get cleaned up a bit and get eye drops. Your baby is most alert in the 30 minutes or so right after birth so it is an important time for you to be able to nurse and bond.

Just incase a c-section becomes a necessity, you should list your wishes for the baby while they are finishing up your surgery, in your birth plan. Put down whether or not you want your baby accompanied at all times by your birth partner. Let them know ahead of time your wishes on them giving your baby a bottle of sugar water or formula while you are in recovery. Make it clear if you want your baby brought to you in recovery or if you want to wait till you get back to your room.

Postpartum Care
Part of your birth plan includes your post-partum care. Most hospitals support and encourage your baby staying in your room with you at all times, vs. going to the nursery at night or while you sleep. You can make it clear in your birth plan what your preference is. Whether or not you want to room-in, or if you just want your baby brought to you for feedings letting you rest as much as possible. You can also list whether or not you want your birth partner to be allowed to stay the night.

Feeding
In your birth plan you will list your intentions on feeding your baby. You can state whether or not you plan on breastfeeding, and if you do breastfeed how often and when you want to do it. That is important in the instance that you choose not to have your baby rooming in with you, but instead in the nursery. You should make it clear if you want to feed the baby on demand, when the baby is hungry, or if you prefer to feed the baby on your schedule, allowing the nurses in the nursery to give the baby formula when he gets hungry.

Miscellaneous
There are always other things you might think of when it comes to your hopes and wishes for a happy and healthy labor and birth. Things like taking pictures, video taping, having music playing, moving around, being allowed to take a bath or shower during labor, etc. If any of these things are important to you, or you can think of others, be sure to list them in your birth plan for the nurses and your doctor or midwife. Happy birthing!

 (For a printable version click here)

Date:

I _______________________________ am creating this birth plan prior to my labor in order to make my wishes clear to my doctor/midwife, and the nurses at the hospital where I am delivering. These are the items I consider important in the birth of my unborn baby and I would like them to be followed as closely as possible whenever able. I understand that a circumstance might come up where either I may change my mind or that my doctor/midwife may feels that it is in my best interest to deviate from my birth plan. I will be flexible, although I ask to be kept informed ahead of time of every aspect of my labor.

My name: ____________________________
My due date: __________________________
My provider’s name: _____________________
Provider’s number: ______________________
My partner’s name: ______________________
Refer to my baby as: _____________________
(baby’s name, son, daughter, your baby)

Pain Medication
When it comes to pain medication I request (check all that apply):

___ Shots through the IV of medication such as Demerol or Stadol
___ An epidural as soon as possible
___ Do not offer pain medication, let me ask for it if I need it
___ No medication at all, I want a drug free birth
___ Other: _______________________________________________
________________________________________________________

Episiotomies and Tearing
When it comes to delivery I prefer (check all that apply):

___ An episiotomy
___ To tear naturally
___ An episiotomy ONLY if necessary
___ Perineal massage
___ Pain medication for stitching up a tear or cut
___ Other: _______________________________________________
________________________________________________________

Visitors
When it comes to visitors during labor and deliver, I prefer (check all that apply):

___ Please allow all visitors to come and go as they please
___ I only want visitors during the early stages of labor
___ No visitors except for my birth partner
___ Do not allow these people: ______________________________
___ Other: _______________________________________________
________________________________________________________

Immediately After Delivery
Immediately after I deliver I prefer (check all that apply):

___ Please lay my baby on my chest immediately
___ Please clean up my baby before bringing him/her to me
___ We are donating/banking the cord blood
___ Please allow the cord to stop pulsating before cutting cord
___ Please allow my partner to cut the cord
___Please allow my partner to stay with the baby
___ Please allow me to breastfeed immediately before you take baby to be cleaned, get eye drops etc.
___ Other: _______________________________________________
________________________________________________________

C-Section
In the case where a c-section is necessary, I prefer the following (check all that apply):

___ Allow my partner to accompany baby to the nursery and stay with the baby at all times while I am being stitched up
___ Bring my baby to my recovery room as soon as possible so I may bond and attempt to nurse/feed
___ Wait till I get situated in my room before you bring me my baby
___ Do not give my baby sugar water or formula in the nursery whether it is through a dropper, or bottle
___ Go ahead and feed my baby in the nursery
___ Other: _______________________________________________
________________________________________________________

Postpartum Care
For my postpartum care, I prefer (check all that apply):

___ I want my baby to room in at all times
___ I would like my baby to go to the nursery at my request
___ Please administer all tests and medications to my baby in my room
___ Allow my partner to have access to the nursery and to be with the baby at all times when the baby is removed from my presence
___ I want my birth partner to be allowed to stay the night
___ I want family and friends, including other children to have free reign when it comes to visitation
___ Other: _______________________________________________
________________________________________________________

Feeding
When it comes to feeding my baby, I prefer (check all that apply):

___ I will be breastfeeding only
___ I will be breastfeeding and supplementing with formula
___ I will be formula feeding only
___ If in the nursery, bring my baby to me to feed on demand
___ Please feed my baby while in the nursery
___ Do not give my baby sugar water or formula in any situation whether via bottle, dropper or other method
___ Other: _______________________________________________
________________________________________________________

Miscellaneous
Other things that are important to me include (check all that apply):

___ I want to take pictures during labor/birth
___ I want to take video during labor/birth
___ I prefer to be able to eat/drink during labor
___ I want to have the freedom to move around until/unless I request pain medicine
___ I want to be able to take a bath or shower to relieve pain during labor
___ Other: _______________________________________________
________________________________________________________

Thank you for taking the time to read my birth plan. Please keep me informed of anything that comes up during labor that might cause me to deviate from my birth plan.

Thanks,

___________________________
Sign your name

___________________________
Print your name

___________________________
Date

by Amy B. Tuteur, MD Ask Dr. Amy.comHas the baby dropped yet? Friends and complete strangers are asking the same question. What are they talking about? How will you know?

By the end of pregnancy, the baby is likely to take a position that will be favorable for the coming journey. Over 95% of all babies will be facing head down, with their chins tucked on to their chest. Some babies, particularly those of first time mothers, will literally drop into the pelvic opening. The cervix may not have dilated, and the baby is still totally within the uterus, but the head is now nestled within the pelvic opening instead of abovdrop, e it. Doctors and midwives refer to this process as engagement.

Engagement is also known as lightening, probably because it provides some relief from common pregnancy symptoms. When your baby drops, pressure on your stomach and diaphragm drops, too. You will probably have less heartburn and shortness of breath. Of course, these symptoms may merely be exchanged for new ones. You may feel increased pelvic pressure, and some women complain that it’s hard to walk because it feels like the baby’s head is between their legs. However, it’s important to remember that many women have no change in their symptoms and never even notice when the baby’s head engages. It is also possible that the baby will not drop until labor begins.

There are other signs that the time for labor may be drawing near. For example, the mucous plug, which has kept the inside of the uterus sealed off from the vagina, falls out as the cervix begins to to soften and thin in preparation for labor. The mucous plug may fall out hours or even days before labor begins. Sometimes the membranes of the amniotic sac rupture (”breaking your water”) minutes or hours before labor begins. If your membranes rupture, you should call your practitioner. Some doctors and midwives prefer that you come in for examination right away. Others will advise you to wait at home to see if labor begins spontaneously.

Many women have other physical symptoms that signal labor is approaching, including diarrhea, low backache, or abdominal cramping. It seems that impending labor may cause psychological changes as well. A few women are seized with the nesting instinct in the hours and days before labor begins. They are suddenly consumed by the urge to clean and arrange things, when just a few days before they were too exhausted to move.

Can you do anything to deliberately start your own labor? There are a lot of old (and new) wives’ tales that you can consider. Some women insist that spicy food started their labors, and others claim it was because they dosed themselves with castor oil. Then there are those who swear by sex, reasoning that even if it doesn’t work, at least they’ll have a good time. Unfortunately, it’s not likely that any of these home remedies are effective. Labor starts when the baby is ready and not one second before.

About the Author
This article was adapted from the book How Your Baby is Born, by Amy B. Tuteur, MD. Dr. Tuteur runs the website Ask Dr. Amy.com where you can ask her your questions.

by Armin Brott

Dear Mr. Dad. I’m taking a childbirth class with my wife but it really seems geared toward the perfect birth. I know they can’t cover every single unexpected thing that could happen, but how can we prepare for contingencies?

Armin answers: As important as childbirth education classes are, there are a few things they won’t teach you but that you really should know.

First, it’s okay to ask questions—as many as you need to. No matter how much reading you’ve done or how wonderful your class was, something unexpected is bound to happen during labor or delivery—it almost always does. In those cases, don’t let the hospital staff steamroller you. Have them explain everything they’re doing, every step of the way. If you miss something the first time, have them explain it again.

Second, it’s okay to stand up for what you want. Most people are wowed by academic credentials and degrees and have a tendency to step back and let the doctors and nurses take control of the whole process, particularly when something a little out of the ordinary happens. Unless it’s a true medical emergency, keep in mind who’s baby is about to be born and insist on having things done your way, to the extent possible.

Third, don’t give in too quickly. Like most busy people, doctors and nurses are sometimes too quick to say “No” to requests–not because it’s the right answer, but because it’s easy. But here’s the deal: If you want the lights dimmed for the delivery and the staff refuses, do it yourself (assuming, of course, that there’s no medical reason not to). If you want to videotape the birth and the doctor won’t let you, ask for an explanation. If you don’t get a good one, do what you feel you should do.

Keep in mind that there’s a big difference between being assertive and standing up for yourself (and for your wife) and being overbearing, obnoxious, and antagonistic. So be nice.

And finally, it’s okay to ask for help. Most childbirth prep classes focus on how you can help your wife—breathing with her, rubbing her back and her legs, telling her stories, feeding her ice chips, and all sorts of other things. But you’ll rarely, if ever, hear that it’s exhausting and sometimes even scary and that you—yes, you—could use some relief and comfort too. One excellent solution to this problem is to get yourself a doula.

About the Author:
Armin Brott, hailed by Time as “the superdad’s superdad,” has written or co-written six critically acclaimed books on fatherhood, including the newly released second edition of Fathering Your Toddler: A Dad’s Guide to the Second and Third Years. His articles have appeared in The New York Times Magazine, Newsweek, American Baby, Parenting, Child, Men’s Health, The Washington Post among others. Armin is an experienced radio and TV guest, and has appeared on Today, CBS Overnight, Fox News, and Politically Incorrect. He’s the host of “Positive Parenting,” a weekly radio program in the San Francisco Bay Area. Visit Armin at www.mrdad.com.

by Armin Brott

Dear MrDad: Every expectant couple I know is taking a Lamaze classes. Is that really necessary?

Armin answers: One of the advantages of taking a childbirth preparation class is that it’ll give you and your wife the opportunity to ask questions about the pregnancy in a more relaxed setting than her doctor’s office. You’ll also get a chance to hang out with other expecting couples and listen to the women swap stories about how much weight they’ve gained, how much their joints hurt, how many times they get up to go to the bathroom in the middle of the night.

Seriously, though, most childbirth classes operate on the belief that the more you learn about pregnancy and birth—from exercise and nutrition to the difference between an epidural and a spinal—the more in control you’ll feel and the less you’ll have to fear.

Also, be careful: People have a tendency to use the word “Lamaze” as a synonym for “childbirth preparation class.” But Lamaze is really only one of a number of very different approaches to dealing with labor and the pain associated with it. Here’s a little background on three of the most common approaches:

• The Lamaze method is based on the idea that a pregnant woman can overcome her pain—which is the way her body reacts to being in labor—by focusing on something else, usually her own breathing. One major goal is to help woman achieve drug-free labors and deliveries but Lamaze also tries to give expectant parents as much information as they can to help them make the most informed decisions possible.
• The Bradley method also emphasizes educating and preparing expectant couples. They also focus on exercise and nutrition. But instead of trying to take the woman’s attention from her pain, the Bradley folks encourage her to experience it fully: groaning, screaming, whatever she feels like. Bradley is the method that introduced the husband/coach and includes dads far more than any of the others.
• The Leboyer method puts its focus much more on the baby than on the mother-to-be. Leboyer maintains that the bright lights and high noise levels usually found in most hospital delivery rooms are quite stressful and upsetting for a newborn. For that reason, Leboyer babies are generally born in quiet, darkened rooms, often with mom fully or partially submerged in warm water.

Classes typically last five to nine weeks and usually run about $100 to $200. Most are offered either privately or through local hospitals so check with your wife’s doctor or the maternity ward for a referral. Whichever approach you and your wife pick, get going on it as soon as you can. What you’ll learn will do a lot to make the rest of the pregnancy calmer and less stressful for both of you.

About the Author:
Armin Brott, hailed by Time as “the superdad’s superdad,” has written or co-written six critically acclaimed books on fatherhood, including the newly released second edition of Fathering Your Toddler: A Dad’s Guide to the Second and Third Years. His articles have appeared in The New York Times Magazine, Newsweek, American Baby, Parenting, Child, Men’s Health, The Washington Post among others. Armin is an experienced radio and TV guest, and has appeared on Today, CBS Overnight, Fox News, and Politically Incorrect. He’s the host of “Positive Parenting,” a weekly radio program in the San Francisco Bay Area. Visit Armin at www.mrdad.com.

When your baby is born he will be given an APGAR score at both one minute and five minutes after birth. Many new parents don’t know what the APGAR is or what exactly it is for. They are just given a number by their doctor or midwife and are supposed to know what it means.

What It Means The APGAR score is a measurement of a newborn’s response to birth and life outside the womb. It was named for its creator, pediatrician Virginia Apgar (1909-1974), who introduced the system in 1952. Ratings are based on the following factors:

Appearance (color)
0 for blue or pale
1 for pink with blue extremities
2 for pink overall

Pulse (heartbeat)
0 for absent (no pulse)
1 for under 100 bpm
2 for over 100 bpm

Grimace (reflex)
0 for non-responsive
1 for grimace
2 for cough or sneeze

Activity (muscle tone)
0 for limp
1 for some reflex
2 for active movement

Respiration (breathing)
0 for absent
1 for slow, irregular
2 for good crying

As you can see, for each factor, there is a score of 0 (poorest), 1 or 2 (best) which may be given. The score is taken at one and five minutes (sometimes also 10 minutes) after birth, the total high score being 10 and the lowest score being 0. The American Academy of Pediatrics made a statement in 1996 regarding the use, and abuse, of the scoring system as anything other than a newborn assessment tool: “APGAR scores are useful in assessing the condition of the infant at birth. Their use in other settings, such as collection of a child’s Apgar score at entry to school, is inappropriate.”

All babies have meconium and will dispense of it through bowel movements at some point, hopefully after they are born. Meconium is the first bowel movements from a newborn that includes cells, mucus, bile, amniotic fluid and lanugo that is stored in the baby’s intestines while in utero. It is dark green, almost black in color.

Most babies will have their first meconium bowel movement within 24 hours of birth, and may have several before the poop changes to a yellow color. The meconium is sticky and tar like and will generally come out in large amounts, larger than the bowel movements will be after the baby gets rid of the meconium. Unlike later bowel movements, the meconium is normally scentless, making the stickiness be the biggest obstacle for new parents.

Sometimes however a baby will pass his first meconium while still in the womb, before the mother-to-be’s water breaks. If this happens the amniotic fluid will be tinted green. In many cases of hospital births where the baby has passed meconium before birth, a special NICU team will be called when the baby is delivered in case there was ingestion of the meconium into the baby’s lungs.

If a newborn does swallow some meconium it can lead to Meconium aspiration syndrome (MAS). While it is estimated that 5%-20% of newborns pass meconium in utero, only 5%-10% of those cases result in MAS. The newborn passing meconium prior to delivery occurs most often in postdate births. It can also be caused by fetal stress during the pregnancy or during labor and delivery.

If the meconium is ingested into the baby’s lungs, three things can occur to the baby; however it does not always happen. Only a third of infants who ingest meconium need breathing assistance. The things that may occur include:

• blockage of airways
• lower gas exchange in lungs
• inflamed airways leading to pneumonia

While it is almost impossible to prevent your baby from passing meconium in utero, it should be comforting to know that it is a common occurrence that most doctors and midwives know of and can properly react too during your labor and the birth of your baby.

Babies who are born premature, or even slightly early may have a thin white hair covering their body and face. This hair is called lanugo, and normally falls off before or shortly after delivery of full term babies.

Lanugo is the name for the hair that grows on the body that is lacking fat, in order to help insulate and regulate body temperature. This happens on fetuses while in the womb, normally around the 5th month of pregnancy, and generally falls off or is consumed by the baby between 36 and 40 weeks of pregnancy. The lanugo is then stored in the babies intestines and helps to make up the meconium, or the first bowel movements your newborn will have.

Lanugo is often described as a soft and downy hair that is covering the newborn. It will be covering the baby’s whole body except for his palms, the sole of his feet, his lips, penis, nails and sides of his fingers and toes. There is no danger to lanugo to the baby or to people who come in contact with the baby.

Properly stated, lanugo is the Latin word for “down”, like the small fine hairs of plants.